no lido in clinic?

[doncorleone]

We haven't had any lido in our clinic for almost a week now. I wanted to know if any other schools are having this issue. They are telling us there is a national shortage, but i wouldn't be surprised if the people responsible for ordering and inventory are incompetent, as it's not the first time we don't have supplies in clinic. Just wanted to know if there really is a shortage or if other schools are having problems.

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[coursedirector2005]

I know that there have been shortages of marcaine in dental carpules for a while. Think this was because of a change in the manufacturer. I am not aware of nor have experienced any shortages of xylocaine or mepivacaine. Is your dental school in the United States?

 

[doncorleone]

yes, colorado

 

[Lesley]

I know that there have been shortages of marcaine in dental carpules for a while. Think this was because of a change in the manufacturer. I am not aware of nor have experienced any shortages of xylocaine or mepivacaine. Is your dental school in the United States?

I can't get any Carbocaine/Mepivicaine HCL either. There is a manufacturer problem and a shortage right now. I'm presently using Septocaine with epi 1:200,000. It's very effective.

 

[DrJeff]

I'm presently using Septocaine with epi 1:200,000. It's very effective.

That's some really nice juice to have in the syringe I just don't even remotely think about not having profound anesthesia on a patient after using a carpule of it! If only it didn't have the lengthy durtion that it does, patients would love it!

 

[Daurang]

There are only 2 companies in North America making lidocaine. One factory caught on fire. Even supply companies are rationing for dentists. Everything is on backordered a few weeks.

 

[BuckeyeDDS]

That's some really nice juice to have in the syringe I just don't even remotely think about not having profound anesthesia on a patient after using a carpule of it! If only it didn't have the lengthy durtion that it does, patients would love it!

Question for you practicing dentists. We have several professors at school who will not use Articaine/Septocaine for IA blocks due to increased risk for parasthesia. Here at OSU, we spend 60 days of our fourth year out in community clinics, and the attending dentists at most sites that I've been to block everything with Septocaine (and, admittedly, I love it!). Their explanation is that the risk of parasthesia with any local anesthetic is very small, so even if the risk with Septocaine is twice an already very small number...what do you get? A very small number still.

What are all of your thoughts and evidence, both anecdotal and literature based, on this?

 

[doncorleone]

we are taught at school to not use septocaine for IA block as well. However, like you said, some practicing dentists and clinics that we go to will use septocaine for mandibular blocks. It was just today that I was flipping through a "dental abstract" magazine that you find lying around the student lounge. there was an abstract about a study in using septocaine and doing a buccal injection on the mandibular instead of an IA, and they said you could still get profound anesthesia on the mandibular molars. we have never been taught that in clinic, i thought it was pretty interesting.

 

[Lesley]

Question for you practicing dentists. We have several professors at school who will not use Articaine/Septocaine for IA blocks due to increased risk for parasthesia. Here at OSU, we spend 60 days of our fourth year out in community clinics, and the attending dentists at most sites that I've been to block everything with Septocaine (and, admittedly, I love it!). Their explanation is that the risk of parasthesia with any local anesthetic is very small, so even if the risk with Septocaine is twice an already very small number...what do you get? A very small number still.

What are all of your thoughts and evidence, both anecdotal and literature based, on this?

Anecdotal experience only. I was using Carbocaine exclusively until the shortage. I don't have a problem with blocks, and Carbocaine works well for me. However, my husband was having a problem with blocks and found when he switched to Septocaine last year in search of a better block, he had better success. He advised me that when working on mandibular premolars or anteriors, you do not need to block, only infiltrate. When using Septocaine, block only for molars. He says Septocaine is very effective given in a ligamajet. I haven't tried that yet. The main difference I've noticed is that it's very quick acting, patients feel profoundly numb very quickly, and because the anesthesia is long acting, even during long procedures, I do not have to give any intermediate anesthesia as I would with the Mepivicaine HCL. Neither of us have experienced any problems. I have no idea when Carbocaine will be available again. As soon as I found out about the shortage, I had my assistant call everyone in town (twice) to see if we could find some. No luck. Meanwhile, although I was, at first, a little skeptical when I first started using the Septocaine, it's very good stuff.

 

[SFPredent]

I think Xylocaine 1:100 (patterson brand) is the exact same as Lidocaine, and is much easier to obtain. Something about the FDA holding it...you have to wait around 4 weeks after an order. I have taken to ordering large amounts 4-6 weeks in advance and always seem to get it.

 

[Lesley]

I think Xylocaine 1:100 (patterson brand) is the exact same as Lidocaine, and is much easier to obtain. Something about the FDA holding it...you have to wait around 4 weeks after an order. I have taken to ordering large amounts 4-6 weeks in advance and always seem to get it.

Thanks for the info. I'll check it out.

 

[capisce?]

For me the old saying "if it 'aint broke, dont' fix it' applies. I've never had a problem with IANBs before with lido, so I don't see a reason to change. Although the risk of parasthesia may be negligible and anecdotal, just the miniscule increase in risk due to the increase in concentration is enough to deter me from using it in blocks. This is especially true since I'm working on some little ones.

I do think it's very good for anesthetizing primary teeth in the mandible w/ an infiltration. The only issue I've had is that due to the pH it seems to burn the kids a little bit on injection regardless of proper topical application and slow injection. If I'm doing a pulp/ssc or ext, I will always block because sometimes infiltrating doesn't do it. Once you lose them, you're done.

It's the same as w/ formo vs. ferric. The old tried and true works fine and is documented to be safe so no need to mess with ferric and the chance of internal resorption.

I don't see the need for septo for blocks except for limited case. The great thing about dentistry though is that we all get to figure out what works best in our own hands.

 

[coursedirector2005]

Just got my issue of the ADA News date March 19 and on page 12 is an article about the shortage and the reasons for it.

 

[DrJeff]

After almost 6 weeks of backorder, the UPS man showed up at my office today with 50 boxes of 2% Mepivicaine with 1:20,000 levonordeferin! Normally when we order things from our main vendor (Sullivan-Schein), you have the item in the office within 24 hrs, and prior to this, worse case back-order scenario has been about 2 weeks. Still haven't received the plain 3% Mepivicaine (no word on back-order date) that was ordered at the same time.

On the flip side, since 50 boxes is much larger than our normal order(10 boxes), the closet where we keep are anesthesia looks like were ready to treat about 10,000 people at once!

 

[SquidsLife]

Question for you practicing dentists. We have several professors at school who will not use Articaine/Septocaine for IA blocks due to increased risk for parasthesia. Here at OSU, we spend 60 days of our fourth year out in community clinics, and the attending dentists at most sites that I've been to block everything with Septocaine (and, admittedly, I love it!). Their explanation is that the risk of parasthesia with any local anesthetic is very small, so even if the risk with Septocaine is twice an already very small number...what do you get? A very small number still.

What are all of your thoughts and evidence, both anecdotal and literature based, on this?

I've had only one case of lingual paresthesia on one of my patients in the last 4 years using septocaine. I love the stuff. I feel especially vindicated using it when a patient comes in telling me "you got any horse tranquilizer doc cause no one can ever get me numb" and then after one IAB with septo they get the most profound anesthesia they've ever had. Wonderful stuff!

By the way, I recently read an article stating the incidence of lingual parasthesia for all anesthetics was not significant enough to warrant a caution of use for septocaine regarding parasthesia. Reported incidence was very similar for Lido and Septo.

I still use Lido for anterior dental treatment but i use Septo for everything else....including mandibular infiltration on pedo.

 

[ItsGavinC]

I still use Lido for anterior dental treatment but i use Septo for everything else....including mandibular infiltration on pedo.

But do you use it for IAs in pedo, or do you just infiltrate everything with pedo rather than give an IA?

 

[SquidsLife]

But do you use it for IAs in pedo, or do you just infiltrate everything with pedo rather than give an IA?

I use a 30 gauge x-short with septo and infiltrate for 1-2 teeth in a mandibular quad. Seems to work really well but I still use Lido for IA's on pedo when there's a full quad of mandibular restorations (if there's more than 2 restorations then the individual infiltrations are too much for the little fella's to handle). Plus i'd have to use more than one carpule of the 4% septo if I infiltrate.....I might consider individual infiltrations if I can get my hands on a 2% septo or a 1:200K epi but the issue of so many injections still is a for me.